Understanding skin conditions associated with pregnancy

During pregnancy, transient changes occur in the body. But one specific aspect that becomes perpetual is pregnancy. Specific pregnancy-specific are three general categories of pregnancy-associated skin conditions: (1) Skin conditions from normal hormonal changes, (2) pre-existing skin conditions that change during pregnancy, and (3) pregnancy-specific skin conditions. Some conditions may overlap categories.

Pregnancy-specific conditions

PUPPP

PUPPP Pruritic urticarial papules and plaques of pregnancy

PUPPP is the most common pregnancy-specific skin condition. It is nothing but a rash in conjunction with severe itching generally developing on the abdomen and striation. There is no specific treatment for PUPPP. Antihistamines and topical or systemic steroids may be prescribed based on the severity of symptoms.

PEMPHIGOID GESTATIONIS

Pemphigoid gestationis is an autoimmune skin disorder that occurs in one out of 50,000 mid- to late-term pregnancies

IMPETIGO HERPETIFORMIS

Impetigo herpetiformis, pustular psoriasis, is a rare skin disorder which usually occurs in the second half of pregnancy. It is unclear if this disorder is specific to pregnancy or is simply exacerbated during pregnancy.

Systemic signs and symptoms of impetigo herpetiformis include nausea, vomiting, diarrhoea, fevdiarrhoeals, and lymphadenopathy. Without any itching but other secondary Medical complications may occur.

PRURITIC FOLLICULITIS OF PREGNANCY

Pruritic folliculitis of pregnancy occurs in the second and third trimesters and presents as erythematous follicular papules (red papules) and sterile pustules. Contrary to its name, pruritus or itching is not a major feature. Spontaneous resolution is observed after delivery. This condition likely is underreported because it often is misdiagnosed as bacterial folliculitis.

The aetiology of pruritic folliculitis during pregnancy is uncertain, and there are no reports of adverse fetal outcomes related to the condition. Treatments include topical corticosteroids, benzoyl peroxide (Benzac), and ultraviolet B light therapy.

HAIR AND NAIL CHANGES

An increase or decrease in hair growth and production is expected during pregnancy. Women experience some degree of hirsutism or excessive on the face or body caused by endocrine changes during pregnancy. Hirsutism generally resolves postpartum, although some women opt for cosmetic removal if the condition persists. This is also accompanied by the thickening of scalp hair. This is caused by a prolonged anagen(active) phase of hair growth. Postpartum, scalp hair enters a prolonged resting (telogen) phase of hair growth, causing increased hair fall, which may last for several months after pregnancy. A few women with a tendency toward androgenetic alopecia may notice hair loss, which may not resolve after pregnancy.

Nails usually grow faster during pregnancy. Pregnant women may experience increased brittleness, transverse grooves, onycholysis (separation of the nail plate from the skin), and subungual keratosis. Most of these conditions resolve postpartum.

INTRAHEPATIC CHOLESTASIS OF PREGNANCY

Intrahepatic cholestasis of pregnancy is a liver disorder caused by restricted bile flow from the liver leading to liver malfunction. The condition usually resolves postpartum with onset in the second or third trimester of pregnancy. Laboratory markers include elevated serum bile acid levels, alkaline phosphatase levels with or without high bilirubin levels, and aspartate and alanine transaminase levels. Diagnosis is based on clinical history and presentation: pruritus with or without jaundice, no primary skin lesions, and laboratory markers of cholestasis. Cholestasis and jaundice in patients with severe or prolonged intrahepatic cholestasis of pregnancy may cause vitamin K deficiency and coagulopathy. 

HYPERPIGMENTATION

All women experience varying degrees of pregnancy-associated hyperpigmentation during pregnancy, with more pronounced hyperpigmentation in women with a darker complexion.

Melasma

Melasma is the most cosmetically troublesome skin condition associated with appearance patches and freckles on the face during pregnancy. The disease occurs in up to 70 percent of pregnant women.

Exposure to sunlight can worsens melasma; therefore, using sunscreens and avoiding excessive exposure to sunlight may help prevent melasma from being exacerbated. While melasma may go away after postpartum, it can last for years. Severe melasma is treated with combinations of topical tretinoin, hydroquinone and corticosteroids.

STRIAE GRAVIDARUM

Striae gravidarum or stretch marks occur in most pregnant women by the third trimester. Striae appear as pink-purple, atrophy, and uneven skin texture. They are more common in younger women

The causes of striae gravidarum are not entirely understood. This is believed to be due to the skin stretching during pregnancy. The stretching causes damage to the elastic fibres and collagen.

Striae gravidarum or stretch marks occur in most pregnant women by the third trimester. Striae can appear as pink-purple, atrophic lines or bands on the abdomen, buttocks, breasts, thighs, or arms. The cause of striae is multifactorial and includes physical factors like stretching the skin to hormonal factors. Numerous creams, emollients, and oils are used to prevent striae; however, there is no evidence that these treatments are effective. Limited evidence suggests that topical treatments containing Centella Asiatica extract, alpha-tocopherol, and collagen-elastin hydrolysates may help prevent striae. However, the effectiveness, safety and efficacy of these treatments are unclear. However, such products are not readily available, and the safety of using Centella Asiatica during pregnancy and the components responsible for their effectiveness are unclear. Further studies are needed before these treatments can be recommended for widespread use.

Most striae fade to pale- or flesh-coloured lines and shrink postpartum, although they usually do not disappear completely. Treatment is nonspecific, including topical Retinoic acid and laser treatment (585 nm, pulsed dye laser).

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